Cowper’s Cut 373: Out to lunch
“To every thing there is a season, and a time to every purpose under Heaven”, as Ecclesiastes, AKA Kohelet, would have it.
Well, to almost every thing.
In one of the most tone-deaf health policy moves of the past decade (and this is a period including the tenures of Matt Hancock, Dr Therese Coffey and Victoria Atkins as Secretaries Of State For Health and the appointment of Chris Hopson as NHS England’s national director of strategy), The Woman In Black, NHS England’s just-departed boss Amanda Pritchard decided that it would be a great idea to have ‘Lunch With The FT’ on her way out of the door.
Denial: not just a river in Cairo
Well, it’s a point of view.
This interview is a genuinely remarkable read, proving that denial is not just a river running through Cairo.
Mrs Pritchard (meeting FT global health editor Sarah Neville at a restaurant in the National Theatre), declared that the NHS, like the NT, must balance long-term investment with a plethora of immediate demands: “you could forget about the building and just concentrate on what you need to do to put on a great show tonight. But if the building starts falling down, you’d regret that decision”.
Das Capital
Gosh my old boots.
It’s almost as if the English NHS’s capital and maintenance backlog had not hit the all-time high of £13.8 billion, having continued its consistent and longstanding growth under Mrs Pritchard’s tenure; and almost as if capital-to-revenue transfers to hide revenue-to-spending imbalances had not likewise gone unchecked on her watch, despite promises to the contrary.
A brief advisory note to Mrs Pritchard: if what you are about to say in an interview with a national newspaper will make your track record look a) pertinent and b) terrible, why not perhaps just … not say it?
It’d be nice to report that things get better from this point onwards, but what it wouldn’t be is true.
Mrs Pritchard claims not only that private capital should be brought in to fix the ever-worsening capital and maintenance backlog, but that it should also be brought in to buy untested AI gubbins (or in the vernacular, to realise the full potential of technologies such as artificial intelligence to boost productivity and improve patient care).
“We are within touching distance of the sort of transformation that’s possible”, she says. Can her appointment to an honorary role at the UK’s home of AI hype, the Tony Blair Institute, be far away?
The exit Boycott
In cricketing terms, Mrs Pritchard’s performance on the subject of her departure was like non-vintage Geoffrey Boycott defensive blocking.
She vouchsafes that SOS Streeting “didn’t ask me to leave”, as if that’s in any way how these things are done. Indeed, she anodynes that “Wes and I have really tried to work closely in this much more ‘one team’ way over the past nine months, which was different to how things had worked in the past”.
Mmmm. If not mmmmmmm. This is Mrs Pritchard trying to airbrush her departure and the abolition of NHS England as simply a natural parting of the ways, which given Wes Streeting’s explicit comments in January that he would not abolish NHSE, just will not wash.
This is meant to be an interview about Mrs Pritchard’s exit. If we’re bringing back payment by results (as we probably are), then the FT should definitely ask for its money back.
Nor is greater enlightenment offered by the Pritchard assertion that NHS England’s statutory operational independence was probably never realistic, via her claim that “it’s too important to the country [and] we spend too much public money for . . . the politics not to be part of it”.
Ahem.
Reading this, one wonders if Mrs Pritchard ever actually met her former boss Simon Stevens, whose rather better-judged exit FT lunch forms a remarkable contrast at just about every level.
Even when Mrs Pritchard makes an ostensibly sensible point, she butts up against her record in office. She states that national leaders must “think about how long it takes to train a doctor — you can’t change your mind every five minutes ... Think about what it requires to put new [digital] systems in place ... It’s not buying the tech — that’s the easy bit. It’s the implementation . . . and some consistency of leadership is really helpful”.
Mmmmmmm.
Joe Talora
This arrives in the week when a public letter from the Chief Data and Analytical Officers Network (CDAON) stepped up earlier complaints about the FDP and its rollout, calling for a “reset” of NHSE’s approach. ‘Cut’ readers are aware of my former paid involvement in Palantir’s health advisory panel, and are equally aware that I have been mentioning in these columns the well-known problems being encountered in the national FDP roll-out.
FDP implementation was very clearly your thing, Amanda.
Her claim that the NHS contributes between 10 and 20 per cent to people’s health has driven some dissent on social media, but without some level of meaningful contextualisation, it’s difficult to know whether this is attempted sociology or achieved speciousness.
‘The weather in future will be good, unless it is bad.’
On the NHS’s tax-funded model, Mrs Pritchard said, “I’m not worried at the moment that ... en masse, we’re going to end up with a rejection of the NHS model … (but in the absence of the improvements and shifts needed to strengthen the service for the long term) “fast-forward 10 or 15 years, and I think we would be having potentially a very different conversation”. About the survival of the taxpayer-funded model? “Most definitely.”
Roll over, Nostradamus, and tell Tchaikovsky the news. This is a triumph of unfalsifiability: it says nothing, and it means less.
Why do the interview?
It’s genuinely hard to see what benefit Mrs Pritchard thought she was going to get out of doing this interview.
If she thinks that she has a worthwhile delivery legacy to claim from her almost four years, then this was a particularly ill-advised time, and indeed delivery basis, to try doing so.
She should simply have left it for a bit. Time, while an appalling beautician, can be a great eroder of memories (AKA healer).
But then, taking that more gradual approach allows other narratives to emerge, as is highly likely. Leaving it for the time being is an approach for those who feel confident that their work can speak for itself.
Nobody would claim that she came into the job at an easy time. There is further mitigation in what became the ‘more Matt Hancock’ 2022 legislation that ended NHS England’s meaningful independence: there is no way on Earth that Simon Stevens would have considered trying to continue in the job on this basis.
However, Mrs Pritchard’s time in the job was not associated with meaningful planning for NHS recovery. She nodded along with ministerial hype, while failing to assemble a limited and achievable set of priorities. She was also in public denial about the NHS productivity collapse, long after that was a tenable position.
This was a lunch guaranteed to provoke indigestion.
Recommended and required reading
A report leaked to The Guardian warns that British cancer patients are being denied life-saving drugs and trials of revolutionary treatments are being derailed by the red tape and extra costs brought on by Brexit.
A Liberal Democrat NHS performance inquiry given to the Mirror found that NHS trolley waits of 24 hours or longer have increased dramatically in recent years. In 2024, there were at least 49,000 incidents of people waiting around a day in A&E after a decision to admit them to hospital to a patient finding a bed. Those over the age of 65 also accounted for almost 70% of all 24-hour trolley waits.
AI is a gamechanging, gamechangey game-changer. (The DHBSC press office says so, so it must be true.)
Shaun has a big Part Two for his ophthalmology story in the Sunday Times.
Steve Black’s latest Mythbuster for HSJ is succinct.